Cheng Jiwei, Zheng Wenjie, Wang Hongwei, Li Changqing, Wang Jian, Zhang Zhengfeng, Zhou Yue
*Department of Orthopaedics, 113th Hospital, Ningbo, Zhejiang, People's Republic of China; and †Department of Orthopaedics, Xinqiao Hospital, the Third Military Medical University, Chongqing, People's Republic of China.
Spine (Phila Pa 1976). 2014 Dec 15;39(26 Spec No.):B60-5. doi: 10.1097/BRS.0000000000000495.
A prospective observational study on 113 patients with 3 years of follow-up.
To evaluate the clinical results of therapy for discogenic low back pain (DLBP) with posterolateral transforaminal selective endoscopic diskectomy and thermal annuloplasty (PEDTA).
Currently, various minimally invasive techniques are widely used to treat chronic DLBP with variable clinical outcomes. PEDTA is considered to be a novel, minimally invasive technique for treating chronic DLBP, but the evidence supporting this technique is very limited, and there are no studies demonstrating at least 3 years of follow-up.
One hundred thirteen consecutive patients with DLBP with positive concordant pain in discography underwent PEDTA from March 2008 to March 2010. These patients included 64 males and 49 females with a mean age of 43.7 years (range, 16-75 yr). The visual analogue scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were evaluated before therapy and each year after surgery. The clinical global outcomes were assessed on the basis of modified MacNab criteria at 3 years after surgery.
Ninety-six patients underwent a single-level procedure, and 17 patients underwent multilevel procedures. One hundred one (89.4%) cases were followed up for 3 years. There were no serious complications observed during follow-up. The success rate (excellent and good) was 73.8%. The visual analogue scale score, Japanese Orthopedic Association score and Oswestry Disability Index had significantly improved at each year after surgery (P < 0.01, compared with presurgery). The success rate in patients who underwent a single-level procedure was remarkably higher than that in patients who underwent multilevel procedures (78.2% vs. 50.0%, P = 0.041).
PEDTA presents a safe and effective treatment for carefully selected groups of patients with DLBP. Better clinical results occurred in patients with single-level discogenic pain.
一项对113例患者进行为期3年随访的前瞻性观察研究。
评估经后外侧椎间孔选择性内镜下椎间盘切除术及热凝纤维环成形术（PEDTA）治疗椎间盘源性下腰痛（DLBP）的临床效果。
目前，各种微创技术广泛应用于治疗慢性DLBP，临床疗效各异。PEDTA被认为是一种治疗慢性DLBP的新型微创技术，但支持该技术的证据非常有限，且尚无至少3年随访的研究。
2008年3月至2010年3月，113例经椎间盘造影显示疼痛一致阳性的DLBP连续患者接受了PEDTA治疗。这些患者包括64例男性和49例女性，平均年龄43.7岁（范围16 - 75岁）。在治疗前及术后每年评估视觉模拟评分、日本骨科协会评分和Oswestry功能障碍指数。术后3年根据改良MacNab标准评估临床总体疗效。
96例患者接受单节段手术，17例患者接受多节段手术。101例（89.4%）患者随访3年。随访期间未观察到严重并发症。成功率（优和良）为73.8%。术后每年视觉模拟评分、日本骨科协会评分和Oswestry功能障碍指数均有显著改善（与术前相比，P < 0.01）。接受单节段手术患者的成功率显著高于接受多节段手术的患者（78.2%对50.0%，P = 0.041）。
PEDTA为精心挑选的DLBP患者群体提供了一种安全有效的治疗方法。单节段椎间盘源性疼痛患者的临床效果更佳。
